Narcissistic wound, narcissistic blow and narcissistic scar are similar concepts to narcissistic injury and are sometimes used interchangeably. Narcissistic scar is a phrase first used by Sigmund Freud in 1920.[2]

It is believed that narcissists have two layers of rage. The first layer of rage can be thought of as a constant anger (towards someone else), and the second layer being a self-aimed wrath.[citation needed]

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Narcissistic rage occurs on a continuum from instances of aloofness, and expression of mild irritation or annoyance, to serious outbursts, including violent attacks.[3] Narcissistic rage reactions are not limited to personality disorders and may be also seen in catatonic, paranoid delusion and depressive episodes.[3]

Narcissism can be considered as a self-perceived form of perfectionism - "an insistence on perfection in the idealized self-object and the limitless power of the grandiose self. These are rooted in traumatic injuries to the grandiose self."[4]

Narcissists are often pseudo-perfectionists and require being the center of attention and create situations where they will receive attention.[citation needed] This attempt at being perfect is cohesive with the narcissist's grandiose self-image. If a perceived state of perfection is not reached it can lead to guilt, shame, anger or anxiety because he/she believes that he/she will lose the imagined love and admiration from other people if he/she is not perfect.[5]

In his 1914 case study of the "Wolfman", Freud identified the cause of his adult neurosis as the moment when "he was forced to realise that his gonorrheal infection constituted a serious injury to his body. The blow to his narcissism was too much for him and he went to pieces."[6] Freud was careful to stress that thereby "he was repeating a mechanism that he had already brought into play once before... when he found himself faced by the fact that such a thing as castration was possible."[7] A few years later, in Beyond the Pleasure Principle, looking at the close of "the early efflorescence of infantile sexual life", Freud maintained that "loss of love and failure leave behind them a permanent injury to self-regard in the form of a narcissistic scar... reflecting the full extent to which he has been 'scorned'."[8] In 1923 he added that "a child gets the idea of a narcissistic injury through a bodily loss from the experience of losing his mother's breast after sucking, & from the daily surrender of his faeces," but insisted that "one ought not to speak of a castration complex until this idea of a loss has been connected with the male genitals."[9] In "Some Psychical Consequences of the Anatomical Distinction between the Sexes" (1925) he famously (or infamously) stated re penis envy that "after a woman has become aware of the wound to her narcissism, she develops, like a scar, a sense of inferiority."[10] Finally, in his very last book, Freud would write of 'early injuries to the self (injuries to narcissism)'.[11]

Freud's concept of narcissistic injury was subsequently extended by a wide variety of psychoanalysts. Karl Abraham saw the key to depression in "a severe injury to infantile narcissism through a combination of disappointments in love" experienced as a "loss of essential narcissistic supplies."[12]Otto Fenichel confirmed the importance of "the decisive narcissistic shocks... narcissistic injuries,"[13] and, building on Freud's concept of a "narcissistic frustration,"[14] expanded such analyses to "borderline cases... Their narcissistic regression is a reaction to narcissistic injuries; if they are shown this fact and given time to face the real injuries and to develop other types of reaction, they may be helped enormously."[15]

Edmund Bergler took a different approach. Bergler assumed that "the preservation of infantile megalomania or infantile omnipotence (we today would say narcissism) is of prime importance... The infant responds with fury to [any] offense to his omnipotent self."[16] Thus for Bergler, "as Freud and Sandor Ferenczi have shown, the child lives in a sort of megalomania for a long period... confronted with some refusal... regardless of its justifications, the refusal automatically provokes fury, since it offends his sense of omnipotence."[17]

In another line of development, we find Lacanians "linking Freud's stress on the narcissistic wound to Lacan's theory of the narcissistic mirror stage,"[18] while in yet another perspective object relations theory highlights "patients who have suffered narcissistic injury, having been made to feel bad about themselves in relations to their primary object(s)...the narcissistic shell;" as well as "rage... against failures in the early holding environment"[19] when childhood omnipotence is challenged too abruptly. If instead "the mother gives time for her infant to acquire all sorts of ways of dealing with the shock of recognising a world that is outside his or her magical control... then the child becomes able to be destructive... instead of magically annihilating that world. In this way actual aggression is seen to be an achievement, as compared with magical destruction."[20]

"Kohut's (1972) 'Thoughts on Narcissism and Narcissistic Rage" has long been considered one of his most brilliant contributions.[21] In it "Kohut constructed a whole spectrum of rage experiences... Kohut viewed narcissistic rage as just one specific band in this whole spectrum, but... he designated the entire spectrum narcissistic rage. This has created some ambiguity."[22] However "Kohut properly contrasted narcissistic rage with mature aggression."[23]

Such narcissistic rage "cannot progress to self-assertiveness because it is the self structure that is enfeebled and vulnerable."[24] Weakness in the self structure leads to the "development of a narcissistic vulnerability: increased sensitivity to disappointments and extreme difficulty in dealing with real or imagined slights and failures. Narcissistic injury follows such experiences and culminates in narcissistic rage."[25]

Kohut's explanation of narcissistic rage and depression stated, "depressions are interrupted by rages because things are not going their way, because responses are not forthcoming in the way they expected and needed." He went further to say that narcissists may even search for conflict to find a way to alleviate pain or suffering in his book The Analysis of the Self.[26]

Narcissistic rage is related to narcissist's need for total control of their environment; according to Kohut includes "the need for revenge, for righting a wrong, for undoing a hurt by whatever means".[27] It is an attempt by the narcissist to turn from a passive sense of victimization to an active role in giving pain to others, while at the same time attempting to rebuild their own (actually false) sense of self-worth. It may also involve self-protection and preservation, with rage serving to restore a sense of safety and power by destroying that which had threatened the narcissist.[27]

Alternatively, according to Kohut, rages can be seen as a result of the shame at being faced with failure.[28] Narcissistic rage is the uncontrollable and unexpected anger that results from a narcissistic injury - a threat to a narcissist's self-esteem or worth. Rage comes in many forms, but all pertain to the same important thing, revenge. Narcissistic rages are based on fear and will endure even after the threat is gone.[29]

To the narcissist, the rage is directed towards the person that they feel has slighted them; to other people, the rage is incoherent and unjust. This rage impairs their cognition, therefore impairing their judgment. During the rage they are prone to shouting, fact distortion and making groundless accusations.[29]

Wide dissemination of Kohut's concepts may at times have led to their trivialization. "You will often hear people say, 'Oh, I'm very narcissistic,' or, 'It was a wound to my narcissism.' Such comments are not a true recognition of the condition; they are throw-away lines. Really to recognise narcissism in oneself is profoundly distressing."[30]